1629022652 NPI number — PIEDMONT EMERGENCY CONSULTANTS, PLC

Table of content: (NPI 1629022652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629022652 NPI number — PIEDMONT EMERGENCY CONSULTANTS, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT EMERGENCY CONSULTANTS, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629022652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11647
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32120-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-274-7800
Provider Business Mailing Address Fax Number:
386-274-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
459 LOCUST AVE
Provider Second Line Business Practice Location Address:
MB 26
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-982-7150
Provider Business Practice Location Address Fax Number:
434-982-7147
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICCIARDI
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-982-7150

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2129517 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: DC8185 . This is a "MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 298868 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 608215700 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8348103 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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